Doctor First, an appointment system you don't have to wait for.

"Doctor First ® is a demand led system that allows Practices to effectively manage patient demand by clinicians talking to all patients. Patients will be assessed on a clinical priority basis.
If either the doctor or patient needs or wants to see the other then an appointment is booked without question."

Improving patient access to primary care will always be a challenge to those working in General Practice, be that meeting NHS targets, patient expectations or just trying to give a good honest service.  It is a balancing act we all juggle with on a daily basis.

Dr Clay tells the story of how he changed his working life, that of his patients and now thousands more in other practices around the country for the better. Today it is known as Doctor First.

“Where we are today was born out of us wanting to improve our own working lives.  We had an increase in practice list size of over 1,000 patients in a year, more demand than actual appointments available, no room for additional doctors or nurses in our building and no more plot upon which to build more rooms. Our surgeries ran late with extras squeezed in, we had dissatisfied patients, harassed staff and stressed doctors. We had reached our own tipping point; we had to change.”

In a fit of desperation they produced what they thought was an unobtainable wish list,

  • to work less;
  • earn more;
  • know daily workload;
  • get away on time;
  • reduce stress;
  • work in a happier environment; and
  • have no patient complaints!

That’s when they developed the idea of using a doctor to filter out the patients that didn’t need to see them but had no other way of obtaining their help, thereby freeing time to help those who did.

“What amazed us was that not only did it reduce our stress; it also made our patients much happier because it gave them direct access to our knowledge without them having to book an appointment with us and attend the surgery. Over the years we’ve honed it to become Doctor First, an effective way of addressing patient demand which allows us to never have to say no to a patient’s request for an appointment."

They found  that only half (or, in a mature system, as low as a third) of the patients want to come in to see a doctor. The rest are helped directly. It means that, for those patients who want to come in, there are enough slots and slots of the right size, to give patients the time they (and the clinicians) need on the day they want it.

“Although we joke that we turn GP’s into receptionists, what we really do is put the two people who need to talk to one another together in the shortest possible time.”

The potential knock-on effects are to reduce inappropriate patient usage of emergency and secondary care admissions and out-of-hours facilities. In addition the reduction in stress amongst staff results in a much more pleasant working environment and a more welcoming reception for patients. The receptionists’ role is to facilitate rather than filter patients’ journeys through the system of primary care.

By having a doctor or senior nurse talk to all patients first they have been able to achieve a service that deals with the illest people first and gives patients appointment lengths that much more closely match their need. This not only gives patients a better service individually but it reduces the stress on doctors and staff and makes it much less likely that clinics overrun.

Productive Primary Care's team help organisations implement the Doctor First system. They work closely with many practices to improve the efficiency of GP appointment systems. Click here for support options.

Dillon Sykes, of PPC Ltd says “Thousands of pounds are wasted in GP practices on unnecessary locum costs to increase capacity when it is not needed. Practices need to look at managing demand more efficiently and not just throwing extra capacity at the problem”.

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Digital First (formerly Digital by default) is a Department of Health initiative which aims to reduce unnecessary face-to-face contact between patients and healthcare professionals by incorporating technology into these interactions. By ‘unnecessary’ they mean, for example, attending a hospital or GP appointment to receive a test result that says everything is OK; or a visit to an outpatient clinic or GP surgery for something that could be discussed on the phone or via email or SKYPE. Digital First is not about replacing doctors or nurses with technology. Patients will still be able to get an appointment with a doctor or a healthcare professional if they choose to. Instead, it is about using technology in healthcare where it can deliver the same high standards in a way that is more flexible and convenient for patients, and at a lower cost.

Doctor First is rightly mentioned in the initiative as a key process for helping General Practice. It is a simple but effective approach for helping both practices and improving services for patients. We are pleased to be aligned to such an important initiative.


Doctor First: eBrochure

Doctor First eBrochure

Benefits of Doctor First on Practice Life...

The following benefits are all associated with the Doctor First system:

  • Patients are seen when they want
  • By whom they want
  • The illest people are seen first
  • DNA’s (Did not attends) have virtually disappeared
  • Complaints have plummeted
  • Doctors and staff work in a much more productive , satisfying way
  • The system is more cost effective releasing money to be reinvested in the practice and further improve patient care
  • Clinicians know what their workload is every day and have a much more control over their working life
  • Stress is reduced in the patients, staff and doctors resulting in a happier working environment
  • There are enough appointments for everyone and so reception staff work in a great environment
  • Staff do not have to make decisions beyond their knowledge base better made by others
  • Staff are able to facilitate patients’ journey through the systems of the practice rather than acting as barriers-

A financial saving to the practice for reinvestment equivalent to over £30,000 per annum per whole time equivalent GP

  • On average every GP has 1,800 patients
  • On average every patient needs to be seen 5 times per year = 9,000 appointments
  • Over 50 weeks that’s 9,000/50 = 180
  • There are 10 sessions in a week
  • That’s 18 patients per session
  • Normally 18 patients each having a 10 minute appointment would take 3 hours to see
  • With Doctor First, each call takes 2 to 3 minutes; Lets say 3 in 10 minutes
  • That makes 60 minutes to deal with 18 people
  • Let’s say 33% to 50% then attend surgery that’s 6 to 9 x 10 minutes = 60 to 90 minutes
  • Total time saved = 180 - 60 – (60 or 90) = 30 to 60 minutes per session
  • That’s 5 to 10 hours per week of a GP’s time = 3 clinical 3 hour sessions @ £200 per session = £600 per week x 50 weeks = £30,000 per GP

“As a result of the work done with Productive Primary Care (PPC), we have changed the way we work and improved access for patients by 200%”
Mr Chris Thompson, Stag Medical Practice, Rotherham

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